Zoom In Zoom Out
Interactive Forms Manager
Current Location: Interactive Forms Manager > Submitter > Forms > Submit Form
Submit Form
Shippensburg Area
HSA Deduction: Election / Change
Action to be taken: *
Start New Deduction  Change Current Deduction  
Stop Deduction  
Amount to withhold per pay: *

It is the responsibility of employees to be aware of IRS Health Savings Account contribution limits for each calendar year. Please consult the IRS website or with a financial or tax advisor if you have questions.

HR Verification:
Yes  No  
Employee is eligible to enroll in a Health Savings Account.

For your information, the following field will be completed by the payroll department.

Pay date change will take effect:
Complete the information below to route your form  Show Instructions
Your Name:*
Your E-mail:*
Confirm E-mail:*
Your Routing Level: General
Send to Approver:*  
Verification Code:*
Verfication Code refresh verification code
Enter the letters as they are shown in the image. Letters are not case-sensitive.
Powered by SchoolStream Copyright © 2003 - 2019 SchoolStream All Rights Reserved.